Anorexia nerviosa y Bioética.Estudio con profesionales de la salud mental sobre internamiento involuntario y capacidad del paciente para la toma de decisiones de tratamiento

Abstract

One of the characteristics of anorexia nervosa is that those who suffer from it often refuse treatment despite the danger that this poses to their health and deny the problem or seem to have difficulties in appreciating the severity of their situation. This raises an important bioethical and legal problem, since it places mental health professionals before the difficulty of combining respect for the autonomy of the person and the duty to provide for their health.Summary: The aim of this doctoral thesis, articulated on a compendium of publications, was to explore the basis for action of mental health professionals in Spain in the face of the refusal of treatment of patients with anorexia nervosa (publication 1), as well as to quantify and compare their attitudes towards involuntary commitment, capacity (publication 2) and towards other aspects related to the provision of medical care (publication 3).Publication 1 presents a qualitative study with a grounded theory methodology in which seven psychiatrists, four clinical psychologists and a third-year resident psychologist were interviewed. The results showed that these professionals articulate patient care around a main category, namely, involuntary hospitalization as a last resort and the search for willingness. This implies a change in the healthcare dynamics with respect to the situation in which the patient’s physical condition is less pressing. Around this central category some important concepts emerge; role stress (cause of change), informal coercion (mechanism of change), weight (trigger of change) and family and chronicity (decision modifiers). It is concluded that the difficulty of reconciling professional demands can imply a reduction in the quality of care and in job satisfaction itself, which forces us to reflect and investigate the foundations of the assumed attributions...